What are Avulsions/ Phlebectomies?
These are used as an alternative to foam sclerotherapy for the treatment of any varicose veins left after endovenous laser ablation has treated the cause.
Unlike foam sclerotherapy, which just involves simple injections of a chemical to kill the varicosities which are then absorbed slowly by the body, avulsions are used to physically remove the varicose veins.
Avulsions may be undertaken at the same time as the endovenous laser ablation, but they do require a considerable volume of local anaesthetic and if the maximum dose of this has already been used for the EVLA, it is often necessary to undertake the avulsions at a separate visit.
The first stage of the procedure is to mark the position of the varicose veins on the skin while the patient is standing up. Once the skin of the leg is cleaned and drapes applied, the tissues over the marked varicose veins are injected with very dilute local anaesthetic to make the procedure painless.
Following this, very tiny incisions are made either with a needle or a fine scalpel blade at intervals of a few centimetres along the course of the varicose veins. A tiny crochet hook is inserted through the incisions and the wall of the vein grabbed and the vein teased out through the incision. Using small forceps, the vein is pulled and eventually detached. The operator then moves onto the next incision and the next and we can often remove quite long segments of vein at a time.
Once all the varicose veins are removed, small adhesive dressings are applied to close the tiny wounds, a bandage is applied to reduce swelling and bleeding and a stocking put on over this.
Foam Sclerotherapy vs Avulsions
Although there are pros and cons to foam sclerotherapy and avulsions and most of our patients are treated with foam sclerotherapy. This is a simpler and quicker procedure to undertake with less post-procedure discomfort in most cases.
The main advantage of avulsions is the speed of resolution of the varicose veins. It is particularly useful therefore if there is a forthcoming event like a wedding that the patient wishes to be ready for in a short timeframe.
Disadvantages of avulsions include an increased risk of bleeding and infection and a greater chance of nerve damage.